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Hugo and Bill

Dr Irvine Stuart ponders the intangible qualities of general practice.

He is small, slim and pin-sharp, with pale blue eyes that are, forgive the cliché, penetrating. He continues to work in his business three days a week. He seldom attends the surgery. Bill is 87.

We had discussed his glaucoma, and I now moved off message, away from the soulless QOF template, into holistic country, which we visit less often these days. So, how are you, Bill? And will your family be with you for Christmas? They would, and he was grateful for that.

His Christmas in 1943 had been very different. My knowledge of the Indian army in the last war was soon exposed. After the fall of Burma, Bill explained, India itself was threatened by a ruthless enemy. He had been in an armoured unit, confusingly referred to as cavalry, ultimately commanding a squadron of light tanks.

He described reaching the carnage of Kohima just after the relief by British units sent in by Bill Slim. Every building was rubble, and the tropical ground had been transformed horrifically into a pinkish mush of blood and hundreds of mutilated bodies. Tears began to accompany this memory, as vivid now as decades ago. He had never seen anything remotely like it. How could men do this? The Japanese army had been held, and India saved, but at a cost Bill has continued to question to this day.

Self-effacing veterans like Bill stop me in my tracks every time. By contrast, my life as a GP, about which I complain regularly, is a breeze. Later, feeling uncomfortable, humble and almost ashamed, I drove out into the country to visit Hugo.

Six weeks younger than I am, Hugo was slowly fading from an aggressive, inoperable oesophageal malignancy. He was visibly weaker each day, literally speechless by now, yet still able to raise a wasted hand in recognition as I entered his bedroom. At no stage throughout his year-long struggle had Hugo ever uttered a word of self-pity, either to me or to his most supportive wife.

For almost 30 years I have known them as patients, yet would never have guessed at their reserves of strength, or their resilience in the face of death. Patients like Hugo are a lesson in courage.

In the eyes of an NHS manager, I was unproductive that day. I could have signalled my business focus by cutting Bill off at any point. Similarly, terminal care earns no points for my practice, and so fails to demonstrate my qualities as a GP – I should presumably be advising yet another teenager to quit smoking. Increasingly, I find myself saddened by this alien world of medicine.

You will know Bill and Hugo. They are out there in your own practices, reminding you of why you went to medical school. They remind us also that there is more to Christmas than mince pies, office parties and unwanted gifts. Our health secretary Andrew Lansley can never have our unique experience, this privilege we sometimes forget in the midst of all the difficulties and diversions we encounter. He may protest at this suggestion, and I would expect him to, but he can never fully understand the subtle, immeasurable nature of our work. And that is his loss.